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Improving Function of RA Activity Measures in EHRs
Arthritis Care Res; ePub 2019 Feb 11; Gandrup, et al
Modifications to the electronic health record (EHR), provider culture, and clinical workflows effectively improved capture of rheumatoid arthritis (RA) disease activity scores and physician satisfaction, but parallel gains in disease activity levels were missing, a recent study found. Yet, capture of RA outcomes alone may not be sufficient to improve levels of disease activity without a comprehensive treat‐to‐target program. Researchers implemented 3 initiatives designed to facilitate performance of the Clinical Disease Activity Index (CDAI): an EHR flowsheet to input scores, peer performance reports, and an EHR SmartForm including a CDAI calculator. They performed an interrupted time‐series trial to assess effects on the proportion of RA visits with a documented CDAI. Mean CDAI scores before and after the last initiative were compared using t‐tests. Additionally, they measured physician satisfaction with the initiatives. They found:
- Data from 995 patients with 8,040 encounters between 2012 and 2017 were included.
- Over this period, electronic capture of CDAI increased from 0% to 64%.
- Performance remained stable after peer reporting and the SmartForm were introduced.
- There were no meaningful changes observed in disease activity levels.
- However, physician satisfaction increased after SmartForm implementation.
Gandrup J, Li J, Izadi Z, Gianfrancesco M, Ellingsen T, Yazdany J, Schmajuk G. Three quality improvement initiatives improved performance of rheumatoid arthritis disease activity measures in electronic health records: Results from an interrupted time series study. [Published online ahead of print February 11, 2019]. Arthritis Care Res. doi:10.1002/acr.23848.
Modifications made to the electronic health record (EHR), clinical workflows, and provider culture have improved the capture of rheumatoid arthritis (RA), along with physician satisfaction. In this study, however, parallel gains in disease activity were missing. Researchers implemented 3 initiatives, including an EHR flowsheet to input scores, peer performance reports, and an EHR SmartForm that included a Clinical Disease Activity Index (CDAI) calculator. A time-series trial was performed in order to analyze the proportion of RA visits documented by CDAI. An increase in physician satisfaction after SmartForm implementation was reported and electronic capture of CDAI increased from 0% to 64% during the study.—Harold E. Paulus, M.D.; Emeritus Professor; University of California, Los Angeles; Division of Rheumatology.